Making Treatment Decisions

Patients with incurable cancers often face difficult decisions about which treatments to try next or whether to pursue treatment at all. To help weigh options, patients are often encouraged to reflect on their personal goals. But what goals do patients with advanced cancer consider most important, and how should they go about making treatment decisions accordingly?

To better understand how patients set their personal goals, Kevin Rand, a psychologist at Indiana University–Purdue University Indianapolis, and his colleagues surveyed 84 patients with incurable cancer who were estimated to have less than a year before their tumor progressed or they died. The patients were asked to write down their current life goals. Then they were asked to list their current goals for cancer treatment. After that, the patients were presented with both lists and asked to select up to five top goals.

Ask Your Doctor

To help you match treatment decisions to your larger life goals, consider asking your doctor:

What is the goal of this treatment?

What is the chance this treatment will prolong or shorten my life?

How will this treatment affect my quality of life?

How will this treatment interfere with my ability to achieve other life goals?

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The study, published in July 2016 in
Supportive Care in Cancer, found the patients’ top treatment goals were fighting or curing the cancer and living longer. Their life goals looked a lot like those of any healthy person. When asked to choose which goals were most important to them, the patients put treatment goals ahead of their life goals.

The researchers concluded that patients tend to think of treatment goals as separate from life goals, only rarely considering the relationship between the two. This didn’t surprise Larry Cripe, a hematologist at ​Indiana University Simon Cancer Center who worked with Rand on the study. Cripe says that patients have a hard time reconciling their life and treatment goals. As a result, patients sometimes make treatment decisions that appear to be at odds with their larger life goals, such as choosing aggressive treatments that may decrease their quality of life. Cripe recommends that all patients have goal-oriented conversations with their doctors early on, when treatment options are often relatively straightforward, to prepare for a time when decisions become more complex.

William Breitbart, a psychiatrist at Memorial Sloan Kettering Cancer Center in New York City, encourages patients to ask themselves questions such as “What gives your life meaning? What are your values? Who are you or who have you been trying to become your whole life, and how do you want to approach dying as the authentic person that you are?” The answers, he says, can help patients maintain a sense of purpose in their lives and choose among treatment options with those larger life goals in mind.